面罩固定整体挡铅技术在鼻咽癌放射治疗中的应用

目的:探讨面罩固定整体挡铅技术在鼻咽癌治疗中的应用.方法:利用鼻咽+颈部CT/MR,采用面罩固定同中心照射,模拟定位摄取颈部X线照片,根据鼻咽癌病灶侵犯的范围勾画照射靶区,制作低熔点挡铅,并在治疗机或模拟机上验证挡块.将2005-2006年收治的124例鼻咽癌患者随机分为利用整体档铅治疗组与调强治疗组进行放射治疗,比较1、3年生存率.结果:1)第一步计划常规面颈联合野及下颈部切线野.第二步计划面颈分野+颈部切线野,侵及口咽时,采用小面颈联合野,后界前移到颈椎椎体前缘,避开脊髓,其颈部后三角区采用电子束补偿照射.2)根据鼻咽CT/MR侵及范围相应扩大局部照射野.整体挡铅治疗的患者1、3年生存率与调强放疗组无明显差异(p＞0.05).结论:1)面罩固定同中心整体挡铅技术可根据鼻咽癌侵及范围勾画个体化照射野计划.2)通过精确适形设野,使鼻咽、口咽、颅底、颈部包括在一个照射野内,靶区设计更合理.剂量分布更均匀,并能有效遮挡附近重要器官.     

建立鼻咽癌调强放射治疗靶区勾画指南的必要性

目的:分析建立鼻咽癌调强放射治疗靶区勾画指南的必要性和可行性.方法:查阅文献参照国内外同行的勾画情况,根据我院常规放疗的经验,科室全体医生共同讨论多次,建立鼻咽癌调强放射治疗靶区勾画的指南,并选择代表性的CT图像进行勾画,然后打印成彩色图谱.选择6例鼻咽癌患者,然后3名放疗科医师分别勾画一侧眼球的外轮廓,然后该3名医师分别独立的勾画鼻咽CTV和淋巴结CTV,另外一名医生勾画出3者的公共体积;最后3名医师再次根据靶区勾画的指南独立的勾画鼻咽CTV和淋巴结CTV,另外一名医生勾画出3者的公共体积,分别计算眼球、根据指南前后勾画鼻咽CTV和淋巴结CTV的公共指数.运用Wilcoxon检验来分析靶区勾画指南是否减小了医师之间的勾画差异.结果:初步建立了鼻咽癌调强放射治疗靶区勾画的指南,3名医师勾画的眼球中位公共指数为96.23(95.27～97.04),3名医师根据指南勾画前后的鼻咽CTV的中位公共指数分别为71.98(67.45～79.71)和91.72(89.79～93.37)(P=0),淋巴结CTV的中位公共指数分别为64.64(54.71～72.73)和91.35(88.87～93.62)(P=0).结论:鼻咽癌靶区勾画指南的建立提高了不同医师勾画靶区的一致性.     

多层螺旋CT在低危和高危胸腺瘤及胸腺癌鉴别诊断中的价值

目的:探讨低危和高危组胸腺瘤及胸腺癌的增强CT特征。方法:回顾性分析61例胸腺瘤及胸腺癌患者,分为低危组胸腺瘤组（n=20）、高危组胸腺瘤组（n=18）和胸腺癌组（n=23）。所有患者均行CT增强检查,分析肿瘤最大径、最小径、形态、密度、边缘、是否存在坏死及钙化、是否存在淋巴结转移或远处转移、是否存在周围组织结构侵袭以及是否出现胸腔积液等。结果:胸腺癌组肿瘤包膜完整性、周围侵犯、是否合并胸腔积液、淋巴结转移,与低危组胸腺瘤组和高危组胸腺瘤组比较,均有显著差异（P＜0.05）;低危组胸腺瘤组与高危组胸腺瘤组比较,在肿瘤的形态、包膜完整性及周围侵犯方面差异均具有统计学意义;低危组胸腺瘤组增强CT值高于高危组胸腺瘤组、高危组胸腺瘤组增强CT值高于胸腺癌组（P＜0.05）。结论:增强CT对低危、高危胸腺瘤及胸腺癌具有良好的鉴别诊断价值。     

鼻咽癌放疗后海绵窦复发再程放疗临床回顾性分析

目的:探讨鼻咽癌放疗后海绵窦复发受侵再程放疗的临床特点及文献复习.方法:回顾分析2000-06- 2006-04我院诊断的鼻咽癌初次治疗后局部海绵窦复发受侵者55例.全部经CT和(或)MR诊断,部分鼻咽局部重新活检;分析海绵窦受侵的CT和MR诊断意义及再治疗的效果、毒副反应和并发症.结果:55例海绵窦受侵复发患者,CT检出13例,MR检出43例.全组主要的临床表现及体征是外展神经麻痹、颅骨破坏,伴发头痛及前组颅神经受损.再程治疗后、2、3和5年生存率分别为92.73％、78.18％、34.54％和9.09％.初治时有无颅底破坏对再次治疗后的生存率有一定影响,但1、2年生存率差异无统计学意义,3、5年以上生存率差异有统计学意义,P＜0.05.初治到复发间隔时间越短再次治疗后生存率越低,与间隔3年以内者比较,间隔＞3年者生存率有明显提高,P＜0.05.结论:MR较CT能更早期准确诊断鼻咽癌复发中海绵窦受侵,头痛和颅神经症状是海绵窦受侵的主要临床体征,放疗后海绵窦处复发再放疗有积极的治疗意义.     

鼻咽癌椎前间隙受侵的MRI评价及预后价值

目的 应用MRI评价鼻咽癌椎前间隙受侵对放、化疗预后的影响。方法 回顾分析2005—2007年间经病理证实的初治及无远处转移鼻咽癌患者333例临床资料。所有病例行鼻咽部和颈部MRI扫描并经二维、三维放疗或加化疗。Kaplan-Meier 法计算生存率并Logrank法检验,Cox法多因素预后分析。结果 随访率95.2%。鼻咽癌椎前间隙受侵139例(41.7%),椎前间隙受侵组较未受侵组T分期、临床分期明显增加(χ²=90.41、54.03,P=0.000、0.000)。鼻咽癌椎前间隙受侵组与未侵犯组5年总生存率(OS)、无远处转移生存率(DMFS)及无局部区域复发生存率(LRFS)分别为58.8%与77.5%(χ²=11.95,P=0.000),77.8%与85.0%(χ²=2.56,P=0.110)及88.3%与91.8%(χ²=1.51,P=0.220)。经N分期调整后两组5年OS差异仍有统计学意义(χ²=9.93,P=0.002)。多因素分析显示椎前间隙受侵不是影响鼻咽癌OS、DMFS、LRFS的预后因素(χ²=0.43、0.08、0.00,P=0.512、0.783、0.971)。结论 鼻咽癌椎前间隙受侵发生率较高且比未受侵者的OS低,但椎前间隙受侵不是影响鼻咽癌患者预后的因素。     

鼻咽癌放疗前后CT图象的变化

本文报道105例鼻咽癌放疗前后作了CT扫描和临床检查结果的比较及其正常组织放射反应,以便进一步了解鼻咽癌放射治疗后变化规律,提高鼻咽癌放射治疗疗效。 鼻咽癌CT检查结果,除2例鼻咽腔内活检证实鼻咽癌外,其余103例在CT图象上都有鼻咽腔内、或腔外形态的改变。其中咽旁间隙受侵者84例,占80.0％。鼻腔侵犯者45例,占42.9％,茎突后区受侵者     

鼻咽癌调强放疗低危危及器官勾画临床意义

目的 鼻咽癌高危危及器官的勾画和限量受到广泛重视,但低危危及器官的勾画常被放疗医师忽视.为此本研究探讨中下咽缩肌、喉及主支气管勾画对其剂量分布的影响,以及与放疗期间咳嗽反应间的关系.方法 回顾性分析2014-06-01-2015 08-30海南省人民医院放疗科收治的68例N2期鼻咽癌的治疗计划及放疗期间的咳嗽反应,根据是否勾画中下咽缩肌、喉及主支气管分为勾画组和未勾画组,两组均为34例.通过剂量-体积直方图(dosse volume histograms,DVH)评估计划靶区(the planning target volume,PTV,包括PTV1、PTV2和PTVnd)和危及器官(organs at risk,OAR,包括咽缩肌、喉、主支气管及甲状腺)剂量分布,以及两组间的咳嗽反应差异.结果 两组靶区(PTV1、PTV2和PTVnd)剂量分布差异无统计学意义.勾画组与未勾画组PTV2的适形指数(conformity index,CI)分别为0.97±0.24和0.93±0.02,P＜0.001.勾画组的咽缩肌V55(t=3.881,P=0.004)、V50(t=5.102,P=0.001)和V40(t=34.028,P＜0.001)均小于未勾画组,两组比较差异均有统计学意义;V30、V25两组比较差异无统计学意义,P＞0.05.勾画组的喉及主支气管接受55 Gy照射的体积V55(t=2.266,P=0.038)、V50(t=6.734,P＜0.001)、V40(t=17.056,P＜0.001)和V30(t=47.28,P＜0.001)小于未勾画组,两组比较差异均有统计学意义;V20、V15两组比较差异无统计学意义,P＞0.05.未勾画组更容易发生3级咳嗽反应.限定主支气管剂量可显著降低甲状腺V40(t=8.728,P＜0.001)、V50(t=9.153,P＜0.001)和V60(t=8.467,P＜0.001).结论 勾画咽缩肌、喉及主支气管可显著降低其高剂量段(40～55 Gy)的受照体积,提高PTV2的适形度,并减轻咳嗽反应,同时可减少甲状腺照射剂量以及40～60 Gy的受照体积.低危OAR的勾画和剂量限定应受到重视.     

鼻咽癌适形调强放疗研究的三个热点问题

引言近年来,适形调强放疗(I MRT)在临床上的应用逐渐增多,本文的目的是将它应用于鼻咽癌治疗时的一些热点问题进行综述,以期引起同行的关注。1鼻咽癌I MRT靶区的勾画适形调强放疗是一种高精度的放疗,只有被照射对象的形状在三维方向上被精确确定之后,适形照射才有意义。在美国第43届肿瘤和放射治疗年会上,研究头颈部肿瘤的I MRT小组对鼻咽癌靶区的选择与勾画已经达成一致[1]。在新的参考标准出台前,该意见具有重要的指导价值,现叙述如下:1.1肿瘤靶体积的勾画肿瘤靶体积(GTV)包括鼻咽部原发肿瘤和转移性淋巴结。原发肿瘤的GTV依靠临床和放射学的评价来确定。淋巴结GTV的诊断标准为:直径>1cm(如果是二腹肌淋巴结,直径>1.2~1.5cm)的淋巴结;球形而不是椭圆形的小淋巴结;内部呈不均质性,提示中心有坏死的淋巴结;三个以上成簇的临界淋巴结[2]。1.2临床靶体积的勾画临床靶体积(CTV)包括可能存在镜下或亚临床侵犯的周围组织。确定鼻咽癌CTV的范围时应考虑肿瘤的部位、大小、分期、分化程度以及形态学类型等因素。鼻咽癌CTV常规应包括颅底、翼板、鼻咽前间隙(内侧为咽,外侧为翼状肌和腮腺深叶),较早的肿瘤也要包括翼...     

局部晚期鼻咽癌同期调强放化疗联合辅助化疗的临床疗效

目的观察同期调强放射治疗联合辅助化疗对局部晚期鼻咽癌的临床疗效和不良反应。方法初治局部晚期鼻咽癌患者49例,按92福州分期Ⅲ期30例,ⅣA期19例。鼻咽和上颈部靶体积采用IMRT技术照射,下颈部和锁骨上靶体积采用下颈前切野常规照射。调强放疗设鼻咽大体肿瘤为GTVnx、颈部阳性淋巴结GTVnd、高危临床靶体积CTV1和低危临床靶体积CTV2。处方剂量分别为GTVnx 73.9Gy/33次、GTVnd及CTV166Gy/33次、CTV2(504~594)Gy/(28~33)次。按EORTC或RTOG标准评价急性反应。全组患者均给与同期化疗,放疗结束予3周期辅助化疗。结果中位随访28月,1、2年局部控制率100％,97．96％,1、2年总生存率(OS) 均为97．96％,1、2年无远处转移生存率95.92％、93.89％。结论局部晚期鼻咽癌同期调强放化疗联合辅助化疗可获得较理想的局部区域控率和总生存率。3~4级急性黏膜炎和3～4级血液系统不良反应是化疗的剂量限制性因素。     

晚期鼻咽癌:274例的临床分析

鼻咽癌(NPC)因其解剖位置关系,故早期诊断困难。肿瘤常侵犯邻近结构与颈淋巴结,诊断时远处转移不到10%,但其后有1/3的病人播散到锁骨下,且随着颈淋巴结的受侵而增加其发病率。早期病例放疗卓有成效,而晚期,特别是有颅底和/或颅神经侵犯后治疗率则低。本文报告一组晚期NPC 采用放疗的临床经验。     

Ringworm in animals in a farm in Assiut

Bericht über das Auftreten von Hautmykosen bei Tieren auf der Farm der Landwirtschaftlichen Fakultät der Universität Assiut. Von 70 Kälbern waren 42 pilzkrank, davon 22 durch T. mentagrophytes, 20 durch T. verrucosum. Von 180 Kühen waren 8 pilzbefalien, sämtlich durch T. mentagrophytes. Von 2 kranken Bullen wurde T. verrucosum isoliert. Auch die 3 Pferde und 2 Maultiere der Farm waren pilzinfiziert; Erreger war in diesen Fällen T. equinum. Auch ein Kalb war von T. equinum befallen. Die gleiche Pilzart wurde ferner von 3 Tierpflegern isoliert, die Pilzherde am Hals und an den Armen aufwiesen.     

Statistical challenges in preprocessing in microarray experiments in cancer

Many clinical studies incorporate genomic experiments to investigate the potential associations between high-dimensional molecular data and clinical outcome. A critical first step in the statistical analyses of these experiments is that the molecular data are preprocessed. This article provides an overview of preprocessing methods, including summary algorithms and quality control metrics for microarrays. Some of the ramifications and effects that preprocessing methods have on the statistical results are illustrated. The discussions are centered around a microarray experiment based on lung cancer tumor samples with survival as the clinical outcome of interest. The procedures that are presented focus on the array platform used in this study. However, many of these issues are more general and are applicable to other instruments for genome-wide investigation. The discussions here will provide insight into the statistical challenges in preprocessing microarrays used in clinical studies of cancer. These challenges should not be viewed as inconsequential nuisances but rather as important issues that need to be addressed so that informed conclusions can be drawn.     

Trends in zygomycosis in children

Zygomycosis, or mucormycosis, is associated with significant morbidity and mortality in both children and adults. Studies in adults have shown an increase in the incidence of zygomycosis, particularly among haemtopoietic stem cell transplant (HSCT) recipients and patients with haematologic malignancies. There is a paucity of data on the epidemiology of zygomycosis in children. We performed a retrospective analysis to describe trends in zygomycosis between 1 January 2003 and 31 December 2010. We used the Pediatric Health Information System (PHIS) database to identify paediatric patients who were diagnosed with zygomycosis during the study period. Administrative data on diagnoses, demographics, underlying conditions and clinical experiences were collected. Summary statistics were calculated and tests for trend were conducted. We identified 156 unique patients with zygomycosis. The prevalence of zygomycosis did not significantly increase over time (P=0.284). The most common underlying condition was malignancy (58%) and over half received intensive care. Voriconazole utilisation among all hospitalised children significantly increased during the period (P=0.010). Our study demonstrates that the incidence of zygomycosis is not significantly increasing. During the time period there was a significant increase in the use of voriconazole among children.     

Hemoglobin in lymphogranulomatosis in children

The peculiarities of hemoglobin content and properties in lymphogranulomatosis were studied in children by different methods. In most patients the content of fetal hemoglobin and methhemoglobin was found to increase and the rate of ferricyanide oxidation of hemoglobin also increases. Simultaneously, the rate of non-homogenicity of basic hemoglobin fractions was observed to increase on account of immunologically different components.     

Dermatomycosis in Goats in India

Summary: In an extensive survey involving 2176 goats 1.56% of goats manifested clinical lesions of ringworm infection. Animals below the age of 6 months were affected most (4.20%). The incidence of infection was higher during the winter months. T. verrucosum, T. mentagrophytes and M. gypseum were isolated from the skin scrapings of 12, 4, and 2 goats respectively. It is suggested that the infected animals could be a source of disease to human population in which the zoophilic dermatophyte invasion is characterized by severe inflammatory lesions of the skin. The zoonotic importance of different dermatophytes is stressed.
Zusammenfassung: In einer ausgedehnten Untersuchung an 2176 Ziegen wurden bei 1,56% klinische Zeichen einer Hautmykose festgestellt. Tiere, die jühger als 6 Monate alt waren, zeigten mit 4,20% am häfigsten Krankheitssymptome. In den Wintermonaten war die Erkrankungshäufigkeit am gröBten. T. vermcosum, T. mentagrophytes and M. gypseum wurden jeweils von 12,4 bzw. 2 Ziegen isoliert. Die inflzierten Tiere köinnen eine Infektionsquelle für die menschliche Bevölkerung darstellen und dort Mykosen mit stark entzündlichen Veränderungen auslösen. Die Bedeutung verschiedener Dermatophyten als Erreger von Zoonosen wird hervorgehoben.     

Sex hormones in women in rural China and in Britain

Plasma concentrations of certain hormones linked to breast cancer risk were measured in age-pooled samples from 3,250 rural Chinese women in 65 counties, and 300 British women, all aged 35-64. In age-groups 35-44, 45-54 and 55-64 respectively, mean oestradiol concentrations were 36% (P = 0.043), 90% (P less than 0.001) and 171% (P = 0.001) higher in the British than in the Chinese women, and mean testosterone concentrations were 48% (P less than 0.001), 68% (P less than 0.001) and 53% (P = 0.001) higher in the British than in the Chinese women. The difference in testosterone concentrations between the two countries appeared to be due largely to the lower average body weight in the Chinese women. Sex hormone binding globulin did not differ significantly between the two countries in age groups 35-44 and 45-54, but was 15% (P = 0.002) lower in the British than in the Chinese women at ages 55-64. Prolactin concentrations did not differ significantly between the two countries in any age group.     

Temozolomide treatment in glioma--experiences in two university hospitals in Finland

Thirty-two patients with relapsing glioma were treated with temozolomide in two university hospitals in Finland. One patient (3%) had complete response and 9 (28%) partial response, with 8 patients (25%) showing stable disease. Median progression-free survival for these 18 patients (56%) was 7 months (range 2-11+). The remaining either had progressive disease (25%) or only clinical evaluation (19%). Karnofsky score improved in 34% of patients and decreased in 3%. Symptoms were alleviated in 44% and deteriorated in 9%. Grade 3-4 toxicity was detected in 9% of the patients. Only 4% of the days in treatment were spent in hospital. An average 1.8 neuroradiological investigations, 6.9 laboratory visits, and 5.3 visits to the oncologist were made. This study confirms that temozolomide has positive effects on the outcome of often heavily pretreated glioma patients. High drug costs are compensated by prolonged home care and even the possibility to maintain working capacity.